Doctors Don't Always Follow Patients' End-of-Life Wishes: Study

If you want your doctor, relatives, and caregivers to follow your end-of-life wishes, you’d better put it in writing. But even that may be enough to make sure your advance medical directives are honored.

That’s the key conclusion of a new study that finds doctors and caregivers, in general, are more likely to take heroic measures to extend the lives of end-stage cancer patients than the patients themselves.

The research, led by members of the Lien Centre for Palliative Care and the National Cancer Centre Singapore, is based on surveys of 211 cancer patients and their caregivers to find out more about their end-of-life preferences.

Patients were asked to choose their most-preferred end-of-life scenarios including a series of options — such as years of life remaining, degree of pain experienced, place of death, level of burden on caregivers, quality of healthcare experience, cost, and source of payment. They then calculated the patients’ wishes into quantifiable costs for care.

They found that patients' willingness to pay to extend their life by one year was valued at $18,570, which is lower than their willingness to pay to avoid severe pain ($22,199), or to die at home ($31,256), and only slightly more than their willingness to pay to receive a high-quality health-care experience ($16,191).

But caregivers had a three-fold greater willingness to pay than patients to extend life by one year.

The findings suggest that physicians and health insurers are putting too much emphasis on life-extending treatments for these patients, said lead researchers Eric Finkelstein and Chetna Malhotra, who published their results in the journal Palliative Medicine.

"Results highlight the importance of pain management, supporting home deaths, and addressing other end-of-life concerns, in addition to efforts to extend life," said Finkelstein.

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